Wednesday, March 03, 2010

Markets in Everything: Bone Marrow. NOT.

"Every year, 1,000 Americans die because they cannot find a matching bone marrow donor. Minorities are hit especially hard. Common sense suggests that offering modest incentives to attract more bone marrow donors would be worth pursuing, but federal law makes that a felony punishable by up to five years in prison.

That is why on October 28, 2009, adults with deadly blood diseases, the parents of sick children, a California nonprofit and a world-renowned medical doctor who specializes in bone marrow research joined with the Institute for Justice to launch a legal fight against the U.S. Attorney General to put an end to a ban on offering compensation for bone marrow donors.

The National Organ Transplant Act (NOTA) of 1984 treats compensation for marrow donors as though it were black-market organ sales. Under NOTA, giving a college student a scholarship or a new homeowner a mortgage payment for donating marrow would land everyone—doctors, nurses, donors and patients—in federal prison for up to five years.

NOTA's criminal ban violates equal protection because it arbitrarily treats renewable bone marrow like nonrenewable solid organs instead of like other renewable or inexhaustible cells—such as blood—for which compensated donation is legal. That makes no sense because bone marrow, unlike organs such as kidneys, replenishes itself in just a few weeks after it is donated, leaving the donor whole once again. The ban also violates substantive due process because it irrationally interferes with the right to participate in safe, accepted, lifesaving, and otherwise legal medical treatment. For more information go here."

MP: This seems like a basic question of property rights. If individuals own their own cells: blood, bone marrow, hair, semen and eggs, then they have a right to sell their own property, i.e. their own cells. If individuals are not allowed to sell their own property, then they don't really own their own cells, and if they don't own their own cells, then doesn't that really mean that the state/government owns your cells?

One of the founding concepts of America is that a person owns themselves, not government or crown.

Compensating organ donors should be a legal. Everyone in the organ transplant business makes money except the donor.

Returning to the concept of self ownership will create a host of problems for government though. It would not only question the legality of government banning drugs and prostitution, but banning Big Macs with a side of salt.

I'm already on the marrow donor registry but it I were called, I really wouldn't mind some compensation for the time and pain it will take.But I'll still give gladly. And encourage any possibility of getting enough people on the registry to put a real dent in the needs of those who, well, need it.

Sethstorm Iran, believe it or not, solved all those problems years ago. People can sell their organs and as a result nobody dies on a waiting list. hey have safe guards against you kinds of phobia. It works and works well in Iran.

Should we bring back indentured servitude? If my body and my life is mine, should a person be allowed to promise 5 years as a slave in return for some amount of pay? Should I be able to sell someone else the right to kill me?

I agree that the issue of buying and selling organs and body parts needs some work. My point here is that it is a matter of where to draw a line, there are no absolutes.

I think everyone doesn't want to see "Recently deceased husband, Type A+, extra hole in head" showing up on ebay.

The problem is that it would be incentivized to happen. While not on E-bay, it would be that person who offers $1m for the body.

Millions of people list their spouses and relatives as beneficiaries on their life insurance policies. Which provide much more economic incentive than some possible compensation for donations. Why would there be some huge wave of sudden deaths?

But this doesn't even matter for bone marrow as the donor stays alive. There would have to be a lot of collusion to surreptitiously steal someone's marrow. With medical professionals making a lot of money from their day jobs, the rewards don't seem worth the risk.

Although I wouldn't donate my kidney, heart, or brain; I did lot of blood donations. It helped to lower my blood pressure, reduce my excess weight, but most of all -- I became addicted to the Florida Orange Juice those Red Cross people served up. On second thought, I think I should donate my brain, and good riddance.

Are we now onto the slippery slope? Shouldn't we eliminate all cash from the mix? Should our organ donor surgeons be donating their time and dedication? Should the guys driving the trucks and the guys programing the algorithms for the lab guys also be time donors? Doesn't America the Beautiful have gobs of donors at every United Way Drive? If we are now so chock-full charitable people and charitable organizations thus why some jokers are not coughing up their equipment, time, connections, and muscle? Coughing it up for free?

I for one will get busy right away. I am going to find the marrow donation list and get my name on it. Additionally, if I donate marrow often enough, they should eventually let me donate this brain of mine. At least I can hope.

I put in safeguards. Only the donor can contract with the transplant network and until the donor is dead, the transplant network doesn't have medical data on the donor. You could put in an extra step of the donor only having a number with the transplant network and only the donor has his name and the number.

Plus there should be limits on the compensation.

A system could be set up that will increase donors and prevent someone from hacking the transplant network and finding people to whack to get body parts.

Here is the basic problem. People who donate blood or marrow for another patient cannot be compensated for one basic reason.....safety. Safety of the patient and safety f the donor. If people are incentivized to donate, they are more likely to lie on their health history. There are many, many reasons why someone cannot donate their cells to a patient which could ultimately hurt the recipient. There just as many conditions that could harm the donor if they were to donate their cells. If incentivized, it is more likely the donor would lie and therefore jeaporadize not only themselves, but also the patient needing that donation.

For instance.....let's say the donor has a heart condition found in young women called Wolf Parkinson White. This causes periods.....when agitated.....where the hear t races to over 200 beats per minute. It can be potentially life threatening. in perfectly good health. Doing a heart monitor will not show it unless it is flared at the time. Were the donor to undergo the surgical process to extract the bone marrow for a young child it is likely that the stress of being put under anesthesia would trigger it. This could be potentially life threatening to the donor. It would most assuredly cause the extraction doctors to terminate the extraction and no donation would occur. On the recipient's side it would likely be deadly. You see, prior to donation, the patient goes through 2-4 weeks of heavy duty prep where they are given high doses of chemotherapy to eliminate the cancer, and will destroy the patient's bone marrow. They will have none left and will be unable to create any more. That is why the marrow donation is needed. Now that there will be no donation of cells.....and now that the patient has no marrow cells left.....it is highly likely the patient will succumb to an opportunistic infection since the marrow is also the patient's immune system. So because the donor refused to tell the transplant team that they had this condition, they have just endangered their own life and more than likely caused the patient to die.

Sure....people can lie right now but if you add compensation the problem will be far greater.

Another issue is that the compensation will ultimately be paid by the patient needing the cells. They already have to swallow too much in my estimation but don't kid yourself into thinking the hospital will eat those costs. The other question is who establishes what the worth is? There could be bidding wars...again with the cost going to the patients.

Yes, there are issues with getting more donors on the registry, but the issue is not being paid. Millions of donors are on the registry out of the kindness of their heart and the willingness to help their common man. It is merely a matter of education. Once people hear about the need and the REAL methods of donation, they sign up. Many people have this belief that donation is horrible. It isn't. Most donate using a non surgical procedure similar to donating plasma. It takes two IV's and a medication for 5 days that could create some muscle and bone aches similar to what you feel as a cold is coming on. This dispells the myths the TV and movies create like "House" and " Seven Pounds" where donation is made to look barbaric.

If this organization were to spend the millions they are currently spending on this compensation campaign, on educating potential donors they would get far better results. There will be no change in the policy because of the risks I highlighted earlier. I encourage the supporters of compensation to put their time, energy, and money towards educating the public about the need for more marrow donors and they will see actual results. The bottom line here is that we need to help the patients in need and compensation is counter-intuitive to that ultimate goal. You have to ask if a thousand dollars in the hand of the donor is worth the life of the patient.

it "just opens the incentive for involuntary extractions of bone marrow which is then sold off with no regards as to the donor."

Yes. Same as owning a TV - because it can be sold, someone might steal it.

"For those who have the knowledge but cannot get a license, they're more likely to do that kind of work."

Yeppers. Knowing how to unplug a TV but unable to get a license as an electrical engineer? Steal!

What makes bone-marrow transfer different from bood/plasma transfer is that the extraction of blood is simple, safe, and (for most of us) painless while the extraction of marrow usually means a full-scale operation with all the associaed risk/pain.

At 1:53 a patient is shown in what is labeled 'actual bone marrow donation.' This is incorrect. That patient looks as if he is receiving bone marrow, or dialysis. Bone marrow harvesting is done under general anesthesia and involves large needles into bones such as the hip and sometimes sternum to withdraw bone marrow.When trying to influence public policy, it is a good idea to be accurate in what you depict in your PR material.